Leg swelling or edema is a common problem that can become debilitating if left untreated. Many causes can be cured pain free, the key is to make the correct diagnosis. Here we review the top 4 reasons for leg swelling.
1) Medications: Edema is a side effect of many common prescription and OTC drugs. Your legs might be swollen as a side effect of the medications listed below.
- Blood pressure pills: Amlodipine (Norvasc), Nifedipine (Procardia)
- NSAIDs: Ibuprofen (Advil, Motrin), Naproxen (Aleve) and Celebrex
- Nerve pills: Gabapentin (Neuontin) and Pregabilin (Lyrica)
- GERD (acid reflux) medications: Pantoprozole (Protonix), Esomeprozole (Nexium), Omeprazole (Prilosec)
- Hormones and steroids: Birth control pills, testosterone, prednisone, Medrol
- Diabetes medications: Pioglitizone (Actos)... especially if taken with Insulin
- Pramipexole (Mirapex) used for Parkinson's disease and restless leg syndrome
Do not stop or change your medication schedule without consulting your doctor!
2) Venous Disease: 40% of women and 15% of men are affected by venous disease. Do any of these signs or symptoms sound familiar?
- Achy leg pain, throbbing, tingling, itching, restless legs, heavy legs, burning, and of course swelling can all be symptoms of venous disease.
- Physical signs may include, bulging varicose veins, skin changes like brown staining (hemosiderin deposition), hardening, thickening, stasis dermatitis (dry chapped looking skin above the ankle), or venous stasis ulcer.
If you have a history of varicose veins, DVT, phlebitis, venous insufficiency, or venous ulceration a vascular surgeon can help you.
4) Lymphedema: Although annoying, this cause of leg swelling is usually painless. Milky lymph fluid is made of fats and proteins that are too large to be taken up by the small venules and is returned via delicate lymphatic channels to larger veins closer to your heart. When lymph channels are obstructed their contents back up and congest the skin. The skin can get tight and develop prominent pores kind of like the texture of an orange, in fact we call this sign "peau d'orange", which is French for skin of an orange.
- If you think you might have lymphedema, try to pinch the skin on top of your second toe. If you can't pinch the skin on top of your 2nd toe, we call this a “positive Stemmer's sign” which is diagnostic for lymphedema.
- Lymphedema can be treated with compression hose, lymphatic massage (MLD), and other manipulatory techniques to push the lymph fluid towards areas with functional lymph channels.
- If compression is too painful, try walking in a pool at chest-high depth for 30 minutes three times per day. The water pressure provides a greater force than any stockings you can comfortably fit into.
4) Lipedema: This is a common disease that is new to the medical scene and frequently missed by doctors. Lipedema is a fat storage disorder. Inflamed, painful fat is trapped in the legs yielding a “bottom heavy” appearance. Lipedema is estrogen mediated so it only occurs in women. It usually begins or fluctuates around times of hormonal stress such as puberty, pregnancy, or menopause. It is frequently mistaken for obesity or lymphedema and to further complicate things, these diseases may occur concomitantly with lipedema. However, remember that toe pinching test you did earlier? Lipedema does not extend to the toes. Ergo you WILL be able pinch the top of your toe (a NEGATIVE Stemmer sign). What to do about lipedema?
- Anti-inflammatory diets and supplements have been recommended to control symptoms. Unfortunately, lipedema fat seems to be resistant to diet, exercise, and even bariatric surgery.
- Liposuction is the only effective treatment for removing painful lipedema fat. This surgery is different from the traditional cosmetic liposuction in that its goal is to remove the inflammatory, painful fat from the legs and butt while keeping the lymphatic vessels intact. Originally developed in Germany, lymph-sparing liposuction for lipedema requires specific training and is now available in the US.
WARNING about vein surgery: Surgery for varicose veins is NOT always necessary! Although safe and effective when you have big bulging veins, some patients are being harmed by unnecessary procedures. Make sure your physician has vascular credentials from the American Board of Surgery. Docs without specific vascular training may be wasting your time, money, and comfort with a procedure that may not resolve your problem.
Kirsten Nathan MS4
S. Scott Tapper MD FACS RPVI